Filling a void in special-needs dental care

With a special-needs daughter who had slipped into a “dental desert,” a frustrated mom pleaded with Dan Burch, DDS, MA, clinical assistant professor in pediatric dentistry at the Texas A&M University College of Dentistry, to not only hear her but, if he could, help her.

That mom’s desperation pushed Burch down a path of research that uncovered a heartbreaking revelation: about 300,000 patients with intellectual disabilities in the Dallas area alone struggle to find dental treatment once they age out of pediatric dental care at the age of 12 or 13. Now, with a five-year, $3.3 million Health Resources and Services Administration (HRSA) grant that Burch secured with Daniel Jones, PhD, DDS, of the Department of Public Health Sciences, the College of Dentistry is expanding its footprint in special-needs dentistry.

Burch says he is one of only a handful of dentists in the Dallas-Fort Worth area who see special-needs teenagers (nearly 10 percent of the population) across their life span. This includes individuals with mild to major intellectual disorders that are developmental in origin or acquired through trauma. Expanded dental health care will also benefit patients with autism, cerebral palsy, Down syndrome, Prader-Willi syndrome and more.

Families typically have a difficult time keeping up with their aged-out special-needs children’s oral health care because many procedures, including routine cleaning, require sedation. Their care becomes more difficult, Burch said, because they are often combative and harder to physically handle as they become fully grown.

“There are very few places that are educational training centers for special-needs dentistry,” said Burch, who named just a handful scattered across the United States. He is striving to make the College of Dentistry’s special-needs program one that other dental schools can emulate. There are only a few such flagship programs in the country, which are mainly in New York and Washington states.

“My hope is to one day make this the flagship program for other programs to look at and come to, and hopefully train doctors to take care of those patients in rural areas and mid-size cities across the nation,” Burch said.

As these patients fall behind in dental care, they have more cavities, gum issues and high rates of tooth loss.

“After these patients turn 13, there aren’t many places they can go,” said Burch, a self-described policy buff with a public health master’s degree in policy and health systems management. “There become fewer and fewer pediatric dentists they can see, and once they turn 18, the number of dentists they can go to for general dentistry is next to none.”

Burch wants to change that by training fellows within the college’s pediatric dentistry residency program, as well as teaching dental students much earlier and more in-depth about how to treat these patients.

As part of the grant, Nina Ray, DDS, joined the College of Dentistry’s pediatric dentistry faculty last summer to focus on special-needs instruction. The college also added the Compromised Care and Hospital Dentistry Fellowship, making it “the first program in the state of Texas to be a special-needs-focused postdoc program,” Burch said.

The program’s first postdoctoral fellows, Alvin Michael ’19, DDS, and Coralie Ciceron, DDS, started in July. Their training will go beyond the school’s traditional compromised-care patient group that include those with diabetes or high blood pressure. They will receive intensive training, including how to have open dialogue with patients with special needs and their caretakers.

Plans for the second phase include introducing more robust special-needs didactic portions into the dental curriculum. Students already receive special-needs instruction, but work is underway to go more in depth for third- and fourth-year students in pediatric dentistry.

“The third stage that we’re working on right now—and I’m really, really hoping it takes off—is to actually have them come into Scottish Rite children’s hospital and work on patients, do hands-on training on those patients,” Burch said. “It’s going to take a little while, but we have reviewed our current contracts between the dental school and the hospital, and it looks like something that we can do.”

Burch said his affinity for special-needs patients goes back to his residency at Howard University Hospital in Washington, D.C., where pediatric patients, as well as life-span special-needs teens and adults, were seen.

“I was trained to be comfortable with this patient base,” he said. He now thinks back to the day he walked into an east Fort Worth office to that crying mom. She told him that he was the only in-network doctor they could find.

“She said, ‘Something really needs to be done. Parents are kind of left out here after our kids become adults.’ That got my wheels turning. That’s the singular story that made me look into and start this program and made me so tenacious at trying to acquire funding to build.”

He made it his personal mission to see to it that Texas’ void in special-needs dental care is filled. After researching the problem, he put together a short list of care facilities and available physicians to share with his patients. Within six months, he had about 1,800 patients on a wait list, pushing him to see 10 to 12 patients daily on top of his usual schedule. Burch notes that a typical dental clinic sees that many patients over a year. But that doesn’t bother him.

“It’s rewarding just helping those families out,” he said.

Burch is working with the Texas A&M Foundation to find donors to help fund and equip dedicated space for the new special-needs program. There’s enough room in the new Clinic and Education Building to accommodate about three to four chairs, he said. If everything goes according to plan, the clinic could be operating sometime next year.

“It’s rewarding because it’s a marginalized group that policy and society doesn’t focus on,” said Burch, who was drawn to a dental health care career to help others, not for any other reward. “I’m okay with just the hugs and smiles.”

This story originally appeared on Dentistry Insider.